摘要
目的探讨呼吸门控技术在CT血管成像(CTA)诊断血液透析通路相关中心静脉狭窄中的应用价值。资料与方法回顾性分析2019年4月—2021年7月安庆市立医院113例血液透析通路功能不良患者的临床资料和呼吸门控双期CTA扫描图像,根据CTA表现将血液透析通路分成动脉段、瘘口段、前臂段、上臂段及中心静脉段,分段记录内瘘有无并发症,分别测量呼吸双时相下左无名静脉管径值。根据临床是否伴肿胀手综合征分为肿胀组27例与非肿胀组86例,比较两组性别、年龄、内瘘并发症、影像学表现及左无名静脉管径的差异。结果两组患者性别、年龄及内瘘使用年限比较,差异均无统计学意义(χ^(2)/t=0.219、−0.026、−0.032,P>0.05)。两组动脉段、瘘口段、前臂段、上臂段间血管病变的发生率比较,差异均无统计学意义(χ^(2)=1.565、0.004、2.647、0.679,P>0.05)。肿胀组根据CTA表现分为中心病变21例,非中心病变6例,中心病变CTA表现为中心静脉管壁增厚、管腔狭窄或闭塞伴上肢静脉曲张,非中心病变CTA表现为上臂或前臂段头静脉狭窄或闭塞伴有侧支或远段静脉扩张而中心静脉无异常。左无名静脉管径比较:组间比较显示非肿胀组吸气相、呼气相左无名静脉管径均高于肿胀组,差异有统计学意义(t=6.456、5.340,P<0.05);两组左无名静脉管径吸气相均高于呼气相,差异有统计学意义(t=9.266、3.830,P<0.05)。肿胀组吸气相左无名静脉管径2.20(0.00,6.60)与非肿胀组呼气相左无名静脉管径6.67(5.23,8.70)存在重叠。结论吸气相下CTA扫描能够准确显示血液透析通路中心静脉的狭窄位置和程度,可避免因呼吸运动而产生假阳性,对诊断左无名静脉狭窄引起的血液透析通路相关肿胀手综合征具有重要价值。
Purpose To explore the application value of respiratory gating technique in CTA diagnosis of hemodialysis access related central venous stenosis.Material and Methods All imaging data of CTA based on respiratory gating technique and clinical data of 113 patients in Anqing Municipal Hospital from April 2019 to July 2021 were retrospectively analyzed with autogenous arteriovenous fistula(AVF)were retrospectively collected.According to CTA findings,AVF features were divided into four segments,including arterial segment,fistula segment,forearm segment,upper arm segment and central venous segment.Internal fistula condition of the different four segments were recorded,and the diameters of left anonymous vein in the inspiratory and expiratory phase were also measured,respectively.All patients were clinically divided into two groups based on swollen hand syndrome,including the swelling group(n=27)and non-swelling group(n=86).The differences in gender,age,complications of internal fistula,imaging findings and lumen diameter of left innominate vein were compared between the two groups.Results There were no significant differences in gender,age,AVF using years between the swelling group and non-swelling group(χ^(2)/t=0.219,−0.026,−0.032,all P>0.05),and there was also no significant difference in the vascular complications among arterial segment,fistula segment,forearm segment and upper arm segment(χ^(2)=1.565,0.004,2.647,0.679,P>0.05).According to the CTA findings in the swelling group,there were 21 cases with central lesions(presenting thickening of the central vein wall,stenosis or occlusion of the lumen with varicose veins of the upper extremity)and 6 cases with non-central lesions(showing stenosis or occlusion of the upper arm or forearm segment of the cephalic vein with collateral or distal vein dilatation and no abnormality of the central vein).The diameters of left anonymous veins of the inspiratory and expiratory phase in the non-swelling group were all significantly higher than those in the swelling group(t=6.
作者
王祥发
史恒峰
宋芹霞
朱娟
侯唯姝
李小虎
WANG Xiangfa;SHI Hengfeng;SONG Qinxia;ZHU Juan;HOU Weishu;LI Xiaohu(Department of Radiology,First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;不详)
出处
《中国医学影像学杂志》
CSCD
北大核心
2022年第10期1057-1061,共5页
Chinese Journal of Medical Imaging
关键词
呼吸门控成像技术
CT血管造影术
血液透析滤过
Respiratory-gated imaging techniques
Computed tomography angiography
Hemodialysis
